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Objetivo: valoración ultrasonografica Doppler del efecto hemodinámico de la administración intravenosa de somatostatina y octreótido. Material y método: aleatorizamos a 45 cirróticos con varices esofágicas para recibir en una hora una infusión intravenosa de somatostatina (SOM, 250 µg), octreotido (OCT, 50 µg) o placebo (PLA). Pretratamiento y a 15, 30, 45 y 60 minutos medimos velocidad media, índice de congestión, volumen de flujo y diámetro de la vena porta además del índice de resistencia en arteria mesentérica superior. Analizamos las concentraciones séricas de bradicinina y péptido intestinal vasoactivo (VIP) en situación basal y a 30 y 60 minutos. Resultados: respecto de los valores basales tanto SOM como OCT provocaron un descenso significativo en la velocidad (-19,41 vs. -11.19%) y flujo portal (-22,79 vs. -12,33%), con aumento del índice de congestión (+17,5 vs. +7,5%) y del índice de resistencia arterial (+7,18 vs. +6,16%) respecto de sus valores basales (p < 0,05). Estos efectos eran ya evidentes a los 15 minutos y se mantuvieron durante todo el tiempo del estudio. Los cambios inducidos en la velocidad y flujo portal eran más pronunciados con SOM que con OCT, sin diferencias en el índice de congestión o en el índice de resistencia arterial. Los niveles plasmáticos de bradicinina y VIP no experimentaron cambios respecto de sus niveles pretratamiento en ninguno de los grupos. Conclusiones: a dosis terapeúticas, somatostatina y octreotido reducen la velocidad y flujo portales, incrementando el índice de congestión y el índice de resistencia en la arteria mesentérica superior. La somatostatina determina una reducción del flujo venoso portal más marcada que la inducida por octreótido a pesar de un efecto similar sobre la resistencia arterial esplácnica.Aim: Doppler-ultrasound assessment of the splanchnic hemodynamic effects of intravenous somatostatin and octreotide administration. Material and method: forty-five cirrhotic patients with esophageal varices were randomized to receive 1-hour intravenous somatostatin (SOM, 250 µg), octreotide (OCT, 50 µg), or placebo (PLA). In baseline and at 15, 30, 45 and 60 minutes of infusion, mean velocity, congestion index, flow volume and diameter of the portal vein, as well as the superior mesenteric artery resistivity index, were measured. Plasma bradykinine and vasoactive intestinal peptide (VIP) concentrations were also measured at baseline and at 30 and 60 minutes. Results: while placebo caused no changes in any of the venous and arterial parameters, SOM and OCT caused a sustained decrease in portal vein velocity (-19.41 vs. -11.19%) and flow (-22.79 vs. -12.33%), and an increase in the congestion index (+17.5 vs. +7.5%) and resistivity index of the superior mesenteric artery (+7.18 vs. +6.16%) from baseline (p < 0.05). These changes were already evident at 15 minutes and remained unchanged over the study period. With respect to OCT, SOM caused a higher reduction in mean velocity and flow in the portal vein, with no significant differences for congestion index and mesenteric artery resistivity index, both increased by SOM and OCT. Plasma bradykinine and VIP concentrations remained unchanged in the three groups. Conclusions: at therapeutic doses, intravenous somatostatin and octreotide reduce portal vein velocity and flow, and increase portal vein congestion index and superior mesenteric artery resistivity index. Somatostatin causes a higher portal flow reduction than octreotide in spite of a similar splanchnic arterial effect.

Aim: Doppler-ultrasound assessment of the splanchnic hemodynamic effects of intravenous somatostatin and octreotide administration., Material and Method: Forty-five cirrhotic patients with esophageal varices were randomized to receive 1-hour intravenous somatostatin (SOM, 250 mg), octreotide (OCT, 50 mg), or placebo (PLA). In baseline and at 15, 30, 45 and 60 minutes of infusion, mean velocity, congestion index, flow volume and diameter of the portal vein, as well as the superior mesenteric artery resistivity index, were measured. Plasma bradykinine and vasoactive intestinal peptide (VIP) concentrations were also measured at baseline and at 30 and 60 minutes., Results: While placebo caused no changes in any of the venous and arterial parameters, SOM and OCT caused a sustained decrease in portal vein velocity (-19.41 vs. -11.19%) and flow (-22.79 vs. -12.33%), and an increase in the congestion index (+17.5 vs. +7.5%) and resistivity index of the superior mesenteric artery (+7.18 vs. +6.16%) with respect to baseline (p < 0.05). These changes were already evident at 15 minutes and remained unchanged during the time of the study period. With respect to OCT, SOM caused a higher reduction in mean velocity and flow of the portal vein, with no significant differences for congestion index and mesenteric artery resistivity index, both increased by SOM and OCT. Plasma bradykinine and VIP concentrations remained unchanged in the three groups., Conclusions: At therapeutic doses, intravenous somatostatin and octreotide reduce portal vein velocity and flow, and increase portal vein congestion index and superior mesenteric artery resistivity index. Somatostatin causes a higher portal flow reduction than octreotide in spite of a similar splanchnic arterial effect.

Aims: We tried to show the demographic characteristic and alcohol intake habits among our outpatients. We study the influence of age, sex, habitat and socioeconomical status on alcoholic habit., Design: Retrospective and institution based study. Patients. 164 patients who were followed up for alcohol liver disease in our outpatient section., Results: Average age to start drinking alcohol was 18.6 (7.36) years, years of alcoholism were 35.4 (13.5) years, average daily alcohol intake was 161.2 (116.7) grams of pure alcohol. Only 16 men (8%) drank less than 60 grams a day. 5 (35.7%) women drank less than 40 grams a day. Life-cumulative alcohol intake was correlated with Maddrey's score at the end of the study (r = +0.407). Average daily alcohol intake was correlated with ultrasonographic features of the liver (r = +0.283), we appreciated that Prothrombin Time was also correlated with ultrasonographic features of the liver (r = +0.301). The percentage of patients who suffer, at least one decompensation of their disease was 39%., Conclusions: Average age to start drinking is about legal age. Life-cumulative alcohol intake was related to Prothrombin Time and ultrasonographic features of the liver.

Objective: most patients with autoimmune hepatitis require long-term treatment, but up to 80% of them will develop collateral effects. The aim of this study was to evaluate the efficacy of deflazacort, an oxazolinic derivative of prednisolone with fewer effects on bone and glucose metabolism, in the maintenance of remission of type I autoimmune hepatitis in patients treated previously with conventional immunosuppressive therapy., Methods: fifteen patients with type I autoimmune hepatitis were included. All patients had been treated previously with prednisone with or without azathioprine until biochemical remission was obtained and the dose could be reduced. Prednisone was then discontinued and deflazacort was started at a dose adjusted to a ratio of 5 mg prednisone per 7.5 mg deflazacort. The biochemical activity (serum ALT and IgG levels) of liver disease was monitored during a follow-up period of 25.8 +/- 7. 7 months., Results: prednisone therapy was followed by a statistically significant decrease in serum ALT (0P: 386 +/- 345 U/L vs 2M 80 +/- 22 U/L, p < 0.02) and IgG (0P 3029 +/- 1934 mg/dL vs 2M 2064 +/- 933 mg/dL, p < 0.05), from the second month of treatment. After changing to deflazacort no alterations in ALT and IgG serum levels were detected except for a mild, transient increase in serum IgG during the first 3 months. During follow-up, 94% of the patients had normal or slightly increased (less than 50% above normal) ALT levels. The titers of ANA and ASMA remained the same in 82% of the patients, decreased in 12%, and increased in the remaining 6%. During follow-up no patient developed arterial hypertension, diabetes mellitus, or changes in visual acuity. Eight patients, all women, complained of dorsolumbar pain which was not related to osteoporosis., Conclusions: deflazacort seems to be useful in maintaining remission of autoimmune hepatitis during a prolonged period of follow-up. Future studies should include a histological evaluation of the patients and a prospective comparative analysis of side-effects.

We report a case of Zieve's Syndrome that developed after an important alcohol consumption in a 32-yr-old female patient. She was admitted to the hospital with anorexia, asthenia and jaundice. Physical examination showed liver stigmata and hepatomegaly. Laboratory tests demonstrated increased aminotransferase levels, hyperbilirubinemia, hyperlipidemia and normocytic and normochromic anemia with dianocytes in peripheral blood smear. Ultrasonography showed a hyperechoic liver and a liver biopsy showed acute and chronic alcoholic liver disease. Clinical evolution was satisfactory and the therapy consisted of blood transfusion, parenteral fluids, B-complex vitamin and a fatty free diet. Jaundice, hyperlipidemia and haemolytic anemia define Zieve's Syndrome (Z.S.) There is a pathogenetic relationship among the clinical and biological phenomena in this syndrome, whose starter is an acute alcohol intake. Haemolysis is the distinctive feature with respect to the classical acute alcoholic hepatitis, and it is due to erythrocyte's metabolic and osmotic instability in relation to lipids abnormalities. Its clinical resolution precedes the normalization of serum lipids levels. Therapy is similar to that for acute alcoholic hepatitis although sometimes the anemia requires blood transfusion.

We studied during 12 months in the Centro de Especialidades Médicas "Esperanza Macarena" 997 patients with functional dyspepsia (324 males and 673 females) with a mean age of 37.4 and 42.6 years respectively. Patients with any organic disease, including diabetes, were excluded from the study. After completing the study we conclude that patients with functional dyspepsia constitute a large group of patients in gastroenterology clinics, that require multiple diagnostic tests, at great cost and scarce therapeutic successes. Only 36.5 percent of all patients had a good treatment response, most being under 40 years of age and with a relatively high cultural level. Therapeutic response depended on age, sex and social level. The best pharmacological results were obtained with cisapride (10 mg before meals).